Factores asociados al uso de servicios sanitarios en personas con esquizofrenia y trastornos afines

Hipótesis: La hipótesis general del estudio es que existen variables del paciente, de los profesionales y de la organización que pueden influir en el uso de servicios sanitarios por parte de los pacientes con esquizofrenia y trastornos afines. Objetivos: Elaborar un modelo explicativo (multinivel) de la utilización de recursos sanitarios en el área de la Unidad de Gestión Clínica de Salud Mental (UGC-SM) del Hospital Regional Universitario (HRU) de Málaga (antiguo Hospital Carlos Haya) por parte de pacientes con esquizofrenia y trastornos afines. Material y método: Estudio observacional, transversal. Para el desarrollo del mismo ha sido necesario proceder a la evaluación psicométrica de un cuestionario de actitudes del personal facultativo de atención primaria hacia el enfermo mental, la psiquiatría y el equipo de Salud Mental. Resultados: Se exponen inicialmente los resultados del análisis descriptivo de las distintas variables recogidas en el estudio: la muestra de pacientes, las variables dependientes y las variables independientes. Posteriormente se realiza el análisis de las actitudes de los médicos de atención primaria hacia el enfermo mental, la psiquiatría y el equipo de Salud Mental, evaluando las propiedades psicométricas del cuestionario seleccionado sobre actitudes. Por último, se realiza el análisis de los factores asociados con la utilización de servicios sanitarios. Se estructura en cuatro modelos de análisis multivariante, según la variable dependiente seleccionada para cada uno de ellos. Se procede a valorar la relación mediante una regresión multivariante. Los cuatro modelos que se estudian se basan en distintos aspectos del uso de servicios sanitarios. En primer lugar se valora el número total de contactos con algún tipo de recurso sanitario por problemas de salud mental. El segundo modelo se centraría en el número de ingresos psiquiátricos en Unidades de Hospitalización de Salud Mental (UHSM). El tercer modelo dicotomiza la variable dependiente según haya existido o no algún tipo de contacto con algún recurso sanitario perteneciente a la red pública de Salud Mental y el cuarto modelo, se presenta como un estudio piloto-exploratorio, en el que se analizaría únicamente el número de contactos con el médico de familia y para ello se ha utilizado una submuestra de pacientes. Conclusiones: Se ha obtenido un cuestionario sobre actitudes de los médicos de atención primaria hacia el enfermo mental, la psiquiatría y el equipo de Salud Mental, adaptado para facultativos de atención primaria, con buenos coeficientes con respecto a su validez de constructo y su fiabilidad, valorada a través de su consistencia. Los factores de los pacientes con esquizofrenia y trastornos afines que influyen en la utilización de servicios sanitarios fueron el nivel de gravedad, el diagnóstico clínico, el estado civil, la edad y el tipo de convivencia. Los factores de los profesionales sanitarios, en concreto de los médicos de atención primaria, que influyen sobre un mayor número de ingresos en las UHSM por parte de los pacientes con esquizofrenia y trastornos afines serían tener un cupo de más de 1500 pacientes y pasar consulta en dos o más consultorios. Los factores de la organización de los servicios sanitarios, en concreto de los Equipos Básicos de Atención Primaria, que influyen en la utilización de servicios por parte de los pacientes con esquizofrenia, fueron la valoración del papel activo del médico de atención primaria y la valoración de la comunicación con la unidad de salud mental comunitaria

Antipsychotic Medication Influences the Discriminative Value of Acylethanolamides as Biomarkers of Substance Use Disorder.

Plasma acylethanolamides (NAEs), including the endocannabinoid anandamide (AEA), have been proposed as circulating biomarkers of substance use disorders. However, the concentration of these lipid transmitters might be influenced by the use of drugs prescribed for either the treatment of addiction or the associated psychiatric co-morbidities such as psychosis. As an example, neuroleptics, used for attenuation of psychotic symptoms and sedation, might theoretically interfere with the monoamine-mediated production of NAEs, obstructing the interpretation of plasma NAEs as clinical biomarkers. To solve the lack of information on the impact of neuroleptics on the concentration of NAEs, we evaluated the concentrations of NAEs in a control group and compared them to those present in (a) substance use disorders (SUD) patients that are not prescribed with neuroleptics, and (b) SUD patients (both alcohol use disorder and cocaine use disorder patients) using neuroleptics. The results demonstrate that SUD patients exhibited greater concentrations of NAEs than the control population, affecting all species with the exception of stearoylethanolamide (SEA) and palmitoleoylethanolamide (POEA). Neuroleptic treatment enhanced the concentrations of NAEs, especially those of AEA, linoleoylethanolamide (LEA), and oleoylethanolamide (OEA). This effect of neuroleptic treatment was observed independently of the drug addiction that motivated the demand for treatment (either alcohol or cocaine). This study remarks the need to control the current use of psychotropic medication as a potential confounding variable when considering the use of NAEs as biomarkers in SUDPartial funding for open access charge: Universidad de Málag

Estudio psicométrico de un cuestionario sobre las actitudes de los médicos de atención primaria hacia la salud mental: Cuestionario MAPSAM-14

Antecedentes: El objetivo de este estudio es la adaptación y el análisis de las propiedades psicométricas de un cuestionario para medir las opiniones y percepciones de los médicos de atención primaria hacia la salud mental. Método: Se trata de un estudio observacional, descriptivo y transversal. Han participado 145 médicos de atención primaria pertenecientes al área de referencia del Hospital Regional de Málaga, que contestaron un cuestionario de 25 items. Con dicho cuestionario se realizó un análisis factorial exploratorio y de consistencia interna. Resultados: Las condiciones de adecuación muestral y esfericidad se cumplieron de forma satisfactoria. En el análisis factorial se obtuvieron 3 dimensiones medidas por 14 ítems que explican el 55.1% de la varianza total: el cuestionario MAPSAM-14 (Cuestionario de Médicos de Atención Primaria y Salud Mental). Conclusiones: Este cuestionario puede ser una herramienta de rápida aplicación, válida y fiable, para conocer la satisfacción de los médicos de atención primaria respecto a su relación con los equipos de salud mental, sus creencias hacia la enfermedad mental y su percepción del nivel de formación en relación con la esquizofrenia y trastornos afines

Estudio psicométrico de un cuestionario sobre las actitudes de los médicos de atención primaria hacia la salud mental: Cuestionario MAPSAM-14

Antecedentes: El objetivo de este estudio es la adaptación y el análisis de las propiedades psicométricas de un cuestionario para medir las opiniones y percepciones de los médicos de atención primaria hacia la sa- lud mental. Método: Se trata de un estudio observacional, descriptivo y transversal. Han participado 145 médicos de atención primaria pertene- cientes al área de referencia del Hospital Regional de Málaga, que contesta- ron un cuestionario de 25 items. Con dicho cuestionario se realizó un aná- lisis factorial exploratorio y de consistencia interna. Resultados: Las condi- ciones de adecuación muestral y esfericidad se cumplieron de forma satis- factoria. En el análisis factorial se obtuvieron 3 dimensiones medidas por 14 items que explican el 55.1% de la varianza total: el cuestionario MAP- SAM-14 (Cuestionario de Médicos de Atención Primaria y Salud Mental). Conclusiones: Este cuestionario puede ser una herramienta de rápida aplica- ción, válida y fiable, para conocer la satisfacción de los médicos de aten- ción primaria respecto a su relación con los equipos de salud mental, sus creencias hacia la enfermedad mental y su percepción del nivel de forma- ción en relación con la esquizofrenia y trastornos afines.Background: The aim of this study is to adapt and analyze the psychometric properties of a questionnaire on the perceptions of general practitioners towards mental health. Method: This is a descriptive cross- sectional, observational study. A total of 145 general practitioners from the reference area of Malaga Regional Hospital answered this 25-item ques- tionnaire; a factorial analysis was then conducted and its internal con- sistency reliability was tested. Results: The adequacy of sampling and sphe- ricity were satisfactorily met. Three dimensions measured by 14 items were found in the factorial analysis explaining 55.1% of its variance: the MAPSAM-14 questionnaire. Conclusions: This questionnaire may be a prop- er tool with which to determine the satisfaction of general practitioners in relation to mental health services, their beliefs and stigma towards mental illness and their level of training in the field of schizophrenia and related disorders

Perceptions about mental illness among general practitioners

Abstract Background General practitioners (GPs) play an important role in the physical care of patients with severe mental illness, so our aim was to analyse the relationships between GPs’ sociodemographic status and worked-related variables and their perceptions about mental illness. Methods A descriptive, cross-sectional study was conducted in the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population comprised all GPs working in the 13 primary care centres (PCCs) in the hospital’s catchment area during the study period. GPs were interviewed to collect data on their attitudes to and knowledge of mental illness, psychiatry and the local mental health team, as well as their sociodemographic status, professional qualifications and experience. Bivariate analysis was carried out. Results 145 GPs answered the questionnaire (77%). ANOVA revealed that most of the PCCs with the best relationship with their mental health team and best attitude to mental illness were in the Central Community Mental Health Unit, which operated a collaborative model of care. Conclusions These results indicated that GPs who worked more closely with their specialist mental health team had a better perception of their relationship with the mental health centre and less stigmatisation in regard to mental illness

Patterns of primary care among persons with schizophrenia: the role of patients, general practitioners and centre factors.

Patients with schizophrenia and related disorders have more physical problems than the general population. Primary care professionals play an important role in the care of these patients as they are the main entry point into the healthcare system. We aimed to identify patient, general practitioner, and primary care centre factors associated with the number of visits of patients with schizophrenia and related disorders to general practitioners. A descriptive, cross-sectional study was conducted in 13 primary care centres belonging to the Clinical Management Unit of Mental Health of the Regional Hospital of Málaga, Spain. The eligible population was composed of patients with schizophrenia and related disorders attending the primary care centres in the study area, and the general practitioners who attend these patients. Our dependent variable was the total number of general practitioner visits made by patients with schizophrenia and related disorders during the 3.5-year observation period. The independent variables were grouped into three: (a) patient variables (sociodemographic and clinical), (b) general practitioner variables, and (c) primary care centre characteristics. Descriptive, bivariate, and multivariate analyses using the random forest method were performed. A total of 259 patients with schizophrenia and related disorders, 96 general practitioners, and 13 primary care centres were included. The annual mean was 3.9 visits per patient. The results showed that younger general practitioners, patients who were women, patients who were married, some primary care centres to which the patient belonged, taking antipsychotic medication, presenting any cardiovascular risk factor, and more frequency of mental health training sessions at the primary care centre were associated with an increased number of visits to general practitioners. The only general practitioner variable that was associated with the number of visits was age, the older the less contact. There were also patient variables involved in the number of visits. Finally, mental health training for general practitioners was important for these professionals to manage patients with schizophrenia and related disorders

Guía de práctica clínica para el tratamiento del trastorno de ansiedad generalizada : basada en el modelo de atención por pasos en atención primaria y en salud mental.

Esta publicación se ha editado en tres formatos: Guía completa, Guía rápida y Guía resumida.YesGuía de práctica clínica para el tratamiento del trastorno de ansiedad generalizada basada en el modelo de atención por pasos en atención primaria y en salud mental

The Inflammatory Signals Associated with Psychosis: Impact of Comorbid Drug Abuse

Psychosis and substance use disorders are two diagnostic categories whose association has been studied for decades. In addition, both psychosis spectrum disorders and drug abuse have recently been linked to multiple pro-inflammatory changes in the central nervous system. We have carried out a narrative review of the literature through a holistic approach. We used PubMed as our search engine. We included in the review all relevant studies looking at pro-inflammatory changes in psychotic disorders and substance use disorders. We found that there are multiple studies that relate various pro-inflammatory lipids and proteins with psychosis and substance use disorders, with an overlap between the two. The main findings involve inflammatory mediators such as cytokines, chemokines, endocannabinoids, eicosanoids, lysophospholipds and/or bacterial products. Many of these findings are present in different phases of psychosis and in substance use disorders such as cannabis, cocaine, methamphetamines, alcohol and nicotine. Psychosis and substance use disorders may have a common origin in an abnormal neurodevelopment caused, among other factors, by a neuroinflammatory process. A possible convergent pathway is that which interrelates the transcriptional factors NFκB and PPARγ. This may have future clinical implications

The Inflammatory Signals Associated with Psychosis: Impact of Comorbid Drug Abuse

Psychosis and substance use disorders are two diagnostic categories whose association has been studied for decades. In addition, both psychosis spectrum disorders and drug abuse have recently been linked to multiple pro-inflammatory changes in the central nervous system. We have carried out a narrative review of the literature through a holistic approach. We used PubMed as our search engine. We included in the review all relevant studies looking at pro-inflammatory changes in psychotic disorders and substance use disorders. We found that there are multiple studies that relate various pro-inflammatory lipids and proteins with psychosis and substance use disorders, with an overlap between the two. The main findings involve inflammatory mediators such as cytokines, chemokines, endocannabinoids, eicosanoids, lysophospholipds and/or bacterial products. Many of these findings are present in different phases of psychosis and in substance use disorders such as cannabis, cocaine, methamphetamines, alcohol and nicotine. Psychosis and substance use disorders may have a common origin in an abnormal neurodevelopment caused, among other factors, by a neuroinflammatory process. A possible convergent pathway is that which interrelates the transcriptional factors NFκB and PPARγ. This may have future clinical implications